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HomeMy WebLinkAbout1524A 1525A (8) � i __' " '__'�--_ _ - .- . __.. _.... _ . . WORKERS'COMPENSATION DECLARATION �� � � � ' � � � � � � �� � I here6y e�f„m that I have a tertiiimte of�o�,e�„o se�t � � �A�PPLlCAT14N-FOR BUILDING� PERMIT ---- in3ure,or o ter�ifitofe of Woikers'Compensofion Insuronce, . or o cerrif�ed copy thereof(Sec.3900,Lab.C.) � �- � ' � � Pol�cyNo73wc005-27@,"¢9d�b NATIONWTDE COUNTY OF LOS ANGELES BUILDING AND SAFETY � Certified copy is hereby furnishad. FOR APPLICANT TO FILL IN euno�raG O ADDRESS 23(z Cerlitied topy is filed with the co�nfy building inspec- BUiI�ING . tiOn fJtpOrfmBnt. ADDRE55 2 62 Dote,fj-30—R7 ApplicantTHF. ANDF.N f;ROTTP ciir zi toCn.urv � CERTIPICATE OF EXEMPTION FROM WORKERS' �� � NO.OF BiDGS. rvEnReSt _ � COMPENSA710N INSURANCE SIZE OF LOT NOw ON l07 � CRO55 (This sac�ion need not be mmpleted if Ihe perml�is Tor one � AUES50R . ,. hundred doliars(E100)or Iess.J TRACT BLOCK lOT NO.' µqp gppK PAGE PARCEI � TEL. US ONE MAP '1 '� ` I certiiy Iha�in�he perfo�mance of Ihe work for which ihis �N N — �( � �� permit is issued,1 shall not employ any person in ony monner � SPECIAL � so as to becoma Subject fo�ho Workeri Compensofion lows. �- ADDRES �DO�C7 CON�ITIONS 0 U Dote Applicont � � Cii ZiP - � . � ARCHIIECf OR TEI. �7TICE TO APPLICANT: li, ofler moking�this Cefli(iCO1B O� ENGMEER DA E N � DISTRICT GROUV �NST ZONE ���EDBY � .emptian, you should becomc subject to the Workers' - /� Campensofion provisians of the Labor Cade,you m�st forih- qDDRE �D V'-3 � � LUc.I wi�h comply.wi�h suth provisions or this permit shall be , . . R. daemed revoked. . TE�� STATISTICAI CU15SiFICATION APT. - CONDO. [n CONTRACT($2 NO. �/ Z � IICENSED CONTRACTORS�ECLl+RATION . . ��C. i CLA55 NO. C� DWELt.UN�TSJ� I hereby aHirm�hat I am licensed under provisions of Chapier 9 aooRE N . (commenting with Sec�ion 7000)of Division 3 of tha Buziness and ��� ��R�� . Professions Code,and my license is in tutl/orce and effect Ci7Y C�a55 BK � VALIDATION �n 5Q �2634 NO.OF NO.OF CHECK LicenseN�mb��y S�O � Lit.CIaS+R � -� SiZE STORIES FAMILIES ONE � . � � YALUATION Conlro[f�HF. ANT]FN C;RnTTP Da1e �+-�n-R7' - DESCRIPTIONOFWORK i NEW S 1S7 ODO ❑ noo ' � �1 5 2.4 A I am ezempt under Sec. . . ALTER t�• • • •`�'� 6.8P.C.for�his reason ' REPAIR s ���,c✓7J , � � Dafe: USE OF ', DEMOI ❑ I •�1 P 5 9 EXISTING BLDG. AFP�ICANT TEL. Signoture � � vRIM NO. ' FINAL • •4�� �5 J�9 cso OWNER•BLIILDER DECLARATION DATE S Z-�`� . . I hareby affirm tha�I am axempt from Ihe Conlrador's License �. - Q 9.� � �S�] Low for 1he following�eason(Section 7091.5, Busineu and ADDRE55 FINAI � Professlons Code): � � � - - - � � - , sY - � 1, os owner of the property, or my employees wilh AD�RESS ~ wages as their sole compensation,will do the work and - ip�q�ITY ' ' � � -�� J�Z$A the srrucrure is not in�ended or of(ered for sale(Section 7044,Business and Professions Code). � - MOVING � � TEt. ; � � I,os owner o!iha praperty,am exclusively coniroCfing CON7RACiOR NO. �'r• •� • • � with licensed comracrors lo consirutt the projact($eo- qDORE55 I •l�]7 5,0 Q tion 7044,Business and Protessions Code�. : . .. - CONSTRUC710N LENDWG AGENCY "- �� ' SEi�BACK YARD HWY T�TP'yROv UNE wioiH � � + ' � • •'b I�O O c=i I hereby affirm ihat Ihere is a consnuction lending agency for FRONT � � " � - the performance of�he work for which Ihis permit is issued - P.l. � � . - �9,� � "$7 (Sec.3097,Civ.C.). SiDE � �� � CITIBANK P.�. � Lender's Name , : . ,. � IDMA Rel.M ' , , P.C.Fee s 418.59 ✓ Pe„„n cee � 664.�50 �- lander's Address444 R_ FT.(1WF.R� T.A 90(171 10.50 � 1 certify that I have reed thts opplicarion ond itate thot the ixioa�ce Fes to^no.a/c M . � - ahove informa�io orrecf.I agree lo cOmply wifh oll Couny Inves�igoiion fee $ ordinances an t e laws reloting to building consrrvction, ioiai Fee 675.�� LDMn aerm.M - R and hereby � z e re:enlatives of this County to anter w uPan fh - ni e erfy for Inapecffon_ pyrposes. . . . . . . ... . . , . ', � C/// LDMA $75 $35 .: _N/� SEE REVERSE FOR E%PLANATORY LANGl1AGE� Signalure oF APPlicont or Agem 7 pofa . .. . . . . . . � \ i PLANS 70 APPUCANT INSPECiOR'S NOTES .. OR�NIi1C.IlU11.i)IlR UICCLAR 1'I�10\ � 1 hereLy af!um IF�o+I am c.emp�fro�+�he Co���o<icr"s � To: � Retumed �.. �.' ' , i � .�Lic��se La �fo �i�e�follo . g ren� �..�Sec� 7031:5) '�. .. . � .. .. .. AOPwved �� ���fi�suorssunJlrilis�rnnr(.ndi..An}cit) urnunh'erbicL .. �.., -.: , �. ..r�� . ..•,. ,,.... . No. Date No- .`-...Daic�.:•. . `-, ..'� :. ' �.� . .. .��_�.- �. ,..�, ... � � .., rryuires u frr ((..rnactru<(,a4�r,�ur�r.,rv Jrrnufrsh, , ' _ _ ' .-- P � c f _._. �u �sr �i r��/rr �i rts� -re�nu �Lurr.r�i.r� . ��.. .. , . �.�I; �/ ✓)pl:.�n�lur�uJ�p�nrut tn Jile u si,�nrd e��te�w�r�1 . . � .. ,.. .... . , ..� � � . __ ._ _..:�- �.. � _! '._. .' _' �. � • . ' . -____._.—____'_.._ . . ..:-_____ ___ _ u i _,Jbat!c is fkrnsrd pur ant rn 71�r p..� ie � �n/,N r Cnr- . su n � . . ,..�-. .� ;,. . � , , ,; ;., .. -' �.� -r.a.,���:l.;ior��r,,au•�cr:�pn•:'Jlr�u,,,n��n<,n,1 u�;rn.,cc. '__ _ __..-__ __._____ . _. _ . .__.'_ _ _.,._ . .:_��. .. _. __._�._- _.__ . .._ .�.___.. rir,n ibOfll nJ Uirirt,m 3.•/!be Itu�inr�c ond Pr��frssinn� I ,. ._ . .- -� -- _ _ .. . ..____: . .-. I,_�"!' __'.:..'�' .: -._._ _.._,.�),,.. � _.____ .___`.�.:. �!.',. -.. __ . '_.Cn:lo/�nr ehdr.bc i����srrilpt tG�•rcfrum q d�f 'FGki.�„r�br . ___ .__ . . ._. . . . utr�R�,t�.r��„�pr�,�n.n�v�„�r.,r;,,n�,/.���r;,,��;r,3i.s r,�. ,.:'. �1. .�.��,.:'. i. ..�._.:.._Requirod .�.' _.L'.-� � � .`.,:-. :.. __._ .._ __ .__ _ ... ... _ _._____. _-_ . dn�afpin�nt/urup�rrnntsv6jrhdenppLi�in(tnuuail �Omo'Roceived �, . nPD�ovols _ , ' or Approved . � .. ponultY n/nnt nrn r�thaii/r r hvndrrJ d.Jlur�/SSl10/.p ,. Yas Na_ , , , ' ` . _. __ — - - -- —_ . :,. � -- - . . .-. -.. � . �._� I,os owner o}rhe p�opr,rly.�o�my employr.�s w,•h Y.o'c•Cert_hmre :l � -��1 1i` .� , �. ���� . � �, � ..._�. ._.. ._ ._ wag.s as thel ole mmpensai on.wJl de thn waL.�nd , , .._.�_.�. .. ..,...__...__"� , �. . . . . , .. . . ____'_ .__ ._ � .. . . � .. ihe siructme is not intended or offe�cd fo�so�e(Sec.70�'.�1 .. . � . � .��. �.; ���•� . ._.._____. ___. . _ . , , reti.iess�nd Prn(c•sriu>cr Cu1e:'!'he C it�� /r'.�I.i:rmr . . HPotih Oepn.irne�i..- ,.. ___'_.. . .�... .�. . _ .__.. __.__ . .__.. .._ . _ _... .._ . _ __. .... :. U � Lu�r Jn�•s rsnt applv rn au oirner uJ(�rnfrrh u 1�.,builJ� , . �. rrr,��.; d �f rF F�.e-DePa�imPnt- _. _:_. .__.'_ _ . ... .. . .__J: � ._: . _o� 1 _ ' .. � _ � (! r ! r/ t !rn 1/nr �.�. -.� . - �tJ oufi!:Lis �n,rr,fl��� j ��riJ J lf:et.-ea I�i � G�nd g . � ,-_.. _... ., . �nrmrnts . .. �� '. pn a �//vr<d/i�r >n!<, '� . •; .�� J 1 �'.: � �. ' ' ` � .._b.nrerrq d�e 5 X r rr � � n i�. � .. ,- � ...- G! e r mIJ u �-�- - - -.. . --- .. .. .. . �"�' . . . h r ath'n unc � GeoloScal. r� . . . �:: .�� : . � .�_ - _._..�..J'.. . . �.;:� _ hurJan/r� pn�dn,�rGn�l�eJiJ�n,t,hi�lJ���unpr - cn nw ihe � . j e�r<�/.rr _. _. _ Oedesnion Proie<ron �..r..�_ .... -__.. , � �_,. .. . . ,. ..1. p x��n� 1. -�.' - ' __ . tl [, • Y ' � (Ferce)(CanoPY) '�: �; . . . ____ ., : ..,_.._.-'._. ._._ .. .' �:. .. .�. .._ � �._�� .Losow ero(ffiepoperf��,arne�cbn�ee(ytnnt.c,c- .ting wnh licensed mnvacrors to cons•rucr.lhe p�o�ec�(Sec. ._ . ., _.. ..'' '.:. _.�'�. _ _... ....- '__'. ..... ....... '.'_`. 70441 Iin.inrss�nd Prn/e•�Sinns`('��:lr: Y'hc(.r�nfru<'fnr's - .____._ . � �� . . Speual I spect�on . � -" �- .:_.- . .. ,. ICanc.11�1asonry)�Weldin9) � ,. __'._ :... __.._ ._--_ _._- _.r. _ � .__�.�._. .�. ..__ rnv aer s n H�e/�pl�In,�n pu�urrr��rnfcrtl u n f.ic c I. J��o •G ' `i,�:• - �/ruilJe ur-irnpro�es,ih�rreurc.�nd u�Gn��i,niructa/ur sa.! Lo�Dro�nnQe �!:� .��.. ' �� .....___. ......... ... .. .........-. __ . __ �,l ts u fl�u !�u A.{J! rucu/furauant f�. thr . . ' . "i -.nnbu�lnsla.rnie7aief.. . .._ . . . . � . � �' ._.. . . . .. . � __.�_�.� I am c.empi under Sec ��. .� ';'.B.BP.C.lo.ih� � Pa•kmg .. ._ _ . .. .. . 5 . .-.__._ __.-___._._-_ ____.. . . . , . . , . � ' - reason . . . � . �. �.� � _ . ._._-__.____. . _ ._____.._.._ ._._._-.... -:. .__ _ ._.._ ..._. _..... ..........'_ _..:.'_ ' ' Dare O � i -.- . .�.�.(- � '- . . .._.'_ '_ _ - . __. . � , , . � ,. .. . ' _'. ' . . . -.., -_'__.._. ..'�" . . ' _ .".... ... . . �, .I: .. .__..._.. __'. .. . . . � �Approvols Dofa ' 1 spe�torf Signaturo �'� .. .. .. .. .... . .. . . , .... . .. . . . . ,..�-;"'.' .;' . . .,_, � � . �.INSPECTOR'S NOTES.�� _ .. � .� tocanon- � _._. ___.___. .... .. .. . . . ' __. _.._..__'. . . (Serhoc4 8 Yards) - 9''__.- _ � � � � . r- -- ��.-�.� � Fovndntions � � � `� � � � �� , Slab . . . . ,`., ,.. .,.. . . . . . ..-_—'.. ..__:.. ___......----�-'--'--- - � .,. . . � -� --'... �, -..-'��--�'. -. ., .._ ...,.. . ... , FramP � �_3_ �{n,� _ . ... - _ � .. , _, . , _,..,, . ..., „ .. . . , . , . '� � . Eneryy insulof�on � ^`1 ..-..____._- ,. �..'__'.' '' '_ _ _ _. .._.c_- ._..'_ . ..� , , „ ,. .. ' ..' I�Qy�I � j , (' lath:Drywall.. . . �.,, � . . _""_._'' _ ._.'_ ___" _ _. ' _ __'_ _ ,_ '___ _' __ ' __" -.. � In�cr or � I ; '. : I . ' lrnh-E.ierfo. . � . . . ... . . . . . _. .___ . .. ._ _ .. . � . . . . :. . _. .i. r � „ . __._'_ ....—'_"_' ' .. - (�.• •T-_', _ . _._. ___ _ _. _.__ . � , HouaeN�mhe._ ,. _ .,� .i'_ _..._._ . ._._____ ._._-...__.__'.__... _�_.__..._ . . .. � , _�,._ "._ _ . .. .. � , . .. . _. , , . . .;. . Correct 8 Fos�ed . , . l, .�... � ���' 1 ���� . . . . � � � . . Final... . . . . �.. . ,. , . . .. _._ _ .. ._ � _ .__._. _.___. . .. .__.__- - ________...__ _.. ...__ . . ... . Ente.c+n Fronf - � � . . . .. . • . _ . . �, ... . � . . . .... .. . . .. _ . - . . ... . _. . . . i.,, _ . .. . . :,s .: � . . ... . . ... , ._. .. .. . ., . ., " �ii ... .. � ��a , , "� '.`.. - ".,.` , �`,' , . .. ... . .: . _. , . .� .� �'�. , . .�. : . . ._�.��..' ����.. �.;. _.._